Women put forward incredible performances in many different sports at the 2012 London Olympic Games. In fact, over the last few years, a growing number of women have been involved in ultra-endurance events such as marathon running, triathlons and Ironman-like competitions.
People participate in these events for various reasons. Some female athletes do it for the challenge or out of true passion for physical activity. Others want to be fit and in optimal cardiovascular health.
In many instances, societal pressures to look good and have trim, lean bodies can be overwhelming for women -- including female athletes. Various forms of advertising glorifying thin women are everywhere. With all of that glowing in one’s face, it can seem that having a little extra weight is like having the plague.
Take, for example, the case with the Australian Olympic swimmer Leisel Jones, derided by the media only a few days ago when they focused on her physical appearance rather than her actual athletic accomplishments. Jones’s situation is a clear display of how superficial the Australian mainstream media has become.
Many female athletes compete in these events professionally and need to be lean for optimal performance. However, both excessive gain and excessive loss of weight can have a significant impact on performance.
Consequently, here is where the problems potentially lie. Many women push themselves to their limits and obsessively seek fit and lean bodies. They are involved in grueling training schedules and competitions that can be taxing on their bodies, often leading to medical complications.
The “female athlete triad” is a syndrome of interrelated conditions that involves disordered eating, low bone mass, and amenorrhea (abnormal absence of menstruation) in physically active women and female athletes. The condition is very common in women participating in ultra-endurance competitions and training as well as in other sports.
It is also not uncommon for women participating in ultra-endurance events and other strenuous activities to suffer from different degrees of reproductive dysfunction (menstrual disturbances).
In fact, a study conducted by Dr. Lisa Micklesfield, an exercise physiologist at the University of Cape Town, showed that the majority of the runners in her study suffered from menstrual dysfunction. “The runners suffering from menstrual dysfunction actually had lower bone mineral density,” she told me in a phone conversation.
Menstrual dysfunction is characterized by suppressed levels of the hormone estrogen. Normal levels of estrogen play a vital role in slowing down bone resorption or breakdown. It is also very important to note that bone mineral density (bone mass) reaches its peak in females by age 20. So, if someone is submitting herself to grueling training sessions, especially around this period, appropriate nutritional support is absolutely essential; without adequate and appropriate nutrition, young women may be really hurting themselves at a critical time when their bodies are trying to build up lifelong bone stores. Moreover, many people are not aware of a key point: Lost bone mass is mostly likely never regained.
In most cases, the problem of female athletes suffering from different types of reproductive dysfunction may very well be linked to poor dietary habits that are mostly defined by an underconsumption of calories or a negative energy balance.
The term “energy balance” refers to the amount of calories spent relative to the amount of calories consumed. A person is in an ideal energy balance or perfect equilibrium when the amount of calories spent matches the amount of calories consumed. Moreover, an ideal energy balance is when there is no caloric deficit or excess.
Most of the menstrual disturbances (amenorrhea) and different degrees of infertility in female athletes seem to be linked to chronic energy deficiency. In other words, the amount of calories an athlete or physically active woman consumes is simply not adequate for meeting the energetic demands of her daily expenditure during exercise. The neuroendocrine system is very sensitive to the stress of exercise in ways that directly affect the reproductive system. States of caloric deprivation can lead to hormonal imbalances, which consequently negatively impact the reproductive system and also impair bone formation.
Dr. Mary Jane De Souza, a world-renowned researcher at the Pennsylvania State University who has done extensive research on the female athlete triad, told me that “when the volume of energy supply is not adequate to meet the energetic demands, the body repartitions energy, taking it away from reproduction and growth and moving it toward other more essential energy-consuming processes such as thermoregulation, cell maintenance and locomotion.”
Groundbreaking research by Dr. De Souza has brought to light the importance of proper nutrition for creating a positive energy balance in an attempt to reverse menstrual irregularities.
The problem with ultra-endurance sports is that an athlete spends a lot of calories preparing for and competing in these events. The energy expenditure is indeed extreme. It is a major challenge to fulfill those needs.
Take, for example, the case with a sport like swimming, where many coaches still use training methodologies that are characterized by a high volume load. An athlete like Michael Phelps may need to consume around 8,000 calories in a day.
That is a staggering amount. Compare Phelps with the regular John Doe who usually has a caloric intake of approximately just 2,500 calories in a 24-hour period. In order for Phelps to compensate for his excessive expenditure, he needs to be eating large quantities of food several times a day.
“The main issue at stake is that most of these athletes rarely devote the necessary time to plan a proper dietary regimen in the same way they do with their training methodologies,” Dr. De Souza said.
“It is a philosophical problem in the sense that they exclude the dietary planning element from their training formula,” she added.
At the moment, the cause of reproductive dysfunction in female athletes is an interesting topic of discussion in the field of exercise physiology. It is well known that both mental and physical stress linked to conditions marked by a caloric deficit or negative energy balance can lead to disturbances of the menstrual cycle.
Consequently, it may be difficult to pinpoint the exact underlying causes of some of the menstrual dysfunction that many athletes present. It is also important to note that there are other pathologies, unrelated to diet, that can lead to menstrual disorders in athletes.
For menstrual dysfunction related to energy deficiency, though, the solutions to the problem may be around the corner. Dr. Micklesfield was intrigued when I asked her if diet alone could resolve the energy balance issue and solve the bone and menstrual dysfunction problems.
“We don’t have any intervention studies to show that correcting energy balance through diet can actually fix the problem,” she said.
A definite answer to the question I posed to Dr. Micklesfield may come from the conclusions of an ongoing landmark study by Dr. De Souza. Her study is the first randomized controlled trial to examine the issue.
“We are randomly assigning female athletes either to get or to not get more food to see if they are able to get their periods back,” Dr. De Souza said.
In the meantime, women have nothing to lose, and maybe everything to gain, by making sure they are getting all the calories they need from a proper diet. By eating properly and paying as close attention to their nutritional regimen as they do to their training, they just may implement ahead of time the practical recommendations of Dr. De Souza’s study that will come out next year.
*Ricardo Guerra is an exercise physiologist. He has an M.S. in sports physiology from Liverpool John Moores University. He has worked with several football clubs and teams in the Middle East and Europe, including the Egyptian and Qatari national teams. The writer can be contacted at [email protected]